ENG2021-0035 SIDE SEWER PERMITPERMIT
PERMIT NUMBER
City of Edmonds
AveSEWER
••01 11
www.cityofedmonds.gov
Description: ROTO ROOTER SPOT REPAIR WITH CLEANOUT ISSUED: 01/28/2021
Address: 9804 EDMONDS WAY EDMONDS WA 98020-5902
EXPIRES: 04/28/2021
Permit Type: SEWER Permit Subtype: PARTIAL LINE Parcel Number: 00391400001401
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT ROTO ROOTER 6321 7th Ave S, Seattle WA 98108 (206)510-5237
CONTRACTOR ROTO ROOTER 6321 7th Ave S, Seattle WA 98108 (206)510-5237
OWNER WINDSOR PARK ESTATES EDMONDS LLC, SEATTLE WA 98104
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
SIDE SEWER PERMIT - PARTIAL REPLACEMENT $110.00 $110.00
REQUIREMENTS
REQUIREMENT TYPE
NOTES
TRAFFIC CONTROL Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flagger must be trained as required by WAC 296-155-305 and must have certification
verifying completion of the required training in their posession.
RESTORATION Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with
asphalt or City approved material prior to the end of the workday - No Exceptions
WARRANTY The contractor is responsible for workmanship and materials for a period of one year following the final
inspection and acceptance of the work.
INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
INDEMNITY
The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries, damages or claims of
any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments
or employees, including but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of
granting this permit.
,f '
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
1 /28/2021
DATE
Printed: Thursday, January 28, 2021 3:41:47 PM 1 of 2
,
SEWER PERMIT
PERMITNUMBER,
i
its,
City of Edmonds
121 5th Ave N, Edmonds WA ..• • 1 11
www.cityofedmonds.gov• •
CONDITIONS
CONDITION TYPE
NOTES
It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in
DAMAGE TO FRONTAGE
City right of Ways or Easements to City Standards caused by or occurring during the permitted
IMPROVEMENTS
project.
ESC REQ
Maintain erosion and sedimentation control per City and SWMMW standard requirements.
Owner/Contractor to provide Side Sewer asbuilt at final inspection. See City Handout E71 for
SEWER ASBUILT
requirements.
All utilities shall be located prior to any excavation. New locates shall be called for if at time of
UTILITY LOCATES
excavation, original locates are no longer identifiable.
INSPECTIONS
INSPECTION TYPE DATE
RESULT
NOTES
COMPLETE
X-2 ENGINEERING FINAL"
E-2 SEWER PRESSURE
E-2 SIDE SEWER
E-9 SEWER ASBUILT
Printed: Thursday, January 28, 2021 3:41:47 PM 2 of 2
OF EDA1040
-'tic. 1 ago
CONTRACTOR INFORMATION:
Company Name:
SIDE SEWER
PERMIT APPLICATION
Company Address: Q ( (o
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City: IFl,-�' I bl�g Zip:
State License #
Expiration Date:
PROPERTY INFORMATION:
Address:
Owner's Name"
Phone #:
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Site Contact:
Phone #: z 5 3
Email #: _
City Business License #
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❑ FULL LINE REPLACEMENT WSPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY THE SUBJECT PROPERTY OWNER.
CERTIFICATIONS NECESSARY FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID WORK.
I REPRESENT AND WARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I HAVE OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE—�� I J �.r /r I p
� l �-,1(j � DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE